How Taiwan used simple tech to help contain Covid-19

In Taiwan, finding someone to talk about their experience with Covid is more difficult than you think.

The island has maintained some of the lowest case rates in the world during the pandemic, lasting more than 200 days in 2020 without a single case.

During its worst outbreak in May 2021, its daily case load amounted to several hundred local cases per day.

Since the Omicron variant arrived in Taiwan in early January, the number of local cases has remained relatively low, in the single figures or low double digits each day.

Given these numbers, there is a certain stigma attached to contracting the virus. The BBC spoke to a Taiwanese man who contracted covid-19 in late January, but did not want to reveal his name or many details for fear of negative reactions or disapproval from others.

He tells us that after testing positive on a home test and then again at the hospital, he was sent to an isolation ward. Police then tracked his movements for 14 days before testing positive, based on self-reported information and his previous QR scans at restaurants and other locations.

That sophisticated tracking system grew out of a relatively low-tech, crowdsourced development process.

G0v, pronounced ‘gov zero’: a largely anonymous collective of tech workers (designers, programmers, activists) has been key in generating ideas.

The collective is best known for its bimonthly hackathons and “forks,” a concept borrowed from programming, where existing open source software is redesigned into a new product.

When Covid-19 hit Taiwan in early 2020, g0v began looking for multi-sourced solutions to emerging issues raised by the crisis, such as mass contact tracing and mask rationing.

The best ideas were then taken to Taiwan’s digital minister, Audrey Tang (also a g0v contributor), who would share them with the Taiwan cabinet.

G0v worked on several proposals to create a robust contact tracking system, from Google-based forms to web pages and apps, but they all turned out to be too cumbersome.

Ultimately, the group came up with a hybrid solution. The system uses quick response (QR) codes and a corresponding 15-digit code, which can be texted free of charge, without a smartphone, to the 1922 hotline at the Central Epidemic Command Center ( CECC) from Taiwan.

The QR-based system was originally designed just for public transportation, Ms. Tang explains, but quickly became much more widely adopted.

More than two million businesses, from shops and cafes to its famous night markets, posted QR codes on their walls in the first week of implementation. Customers must scan them each time they walk into a business, text 1922, or fill out an old paper-and-pencil form (kept on file) in the event of a community outbreak.

These QR codes have allowed local health authorities to work backwards to track a person’s movements when a positive case is detected, a painstaking and labor-intensive procedure only made possible by some of the lowest case rates in the world.

Despite strict border controls, authorities have still investigated six million possible contacts, according to data from the Central Epidemic Command Center (CECC).

Since the first confirmed positive case of Covid-19 in Taiwan in January 2020, there have been another 20,156 confirmed cases.

Taiwan’s cell phone networks were also used in contact tracing to find and contact people who may have been exposed to the virus.

For example, in early 2020, health authorities texted more than 627,000 people who may have come into contact with COVID-positive passengers after they disembarked in northern Taiwan from a Japanese cruise ship.

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While easy to use, contact tracing has raised some important questions about the privacy of an individual’s data in many countries, a concern that Ms Tang said was taken into account in the creation of the systems themselves. from Taiwan.

Cell tower data, for example, was chosen over global positioning system (GPS) data because it can only provide an approximate (rather than exact) location of the user, says Ms Tang. While contact tracing data is also deliberately decentralized, it is deleted after 28 days and kept out of the reach of prosecutors.

She says that the phone company, the venue, and the creator of the QR code only have fragmented data on each individual.

“So these different parts are just storing part of the puzzle piece, and without putting them together, a cybersecurity breach or something doesn’t really reveal anything useful.”

Strict travel restrictions excluding most foreigners have largely been in place since early 2020, keeping the virus out of Taiwan and its outlying islands. The few visitors that arrive are tracked.

Your travel data is sent in batches to the National Health Insurance Administration, Taiwan’s answer to the UK’s National Health Service, to be stored for a period of time after your arrival.

They must also undergo a mandatory quarantine: 14 days in a quarantine hotel or at home, followed by 7 days of “self-management of health”. During the 21-day period, they receive calls and text messages about their health status from the CECC and the local police station.

While vaccines became widely available in countries like the US and UK in 2021, Taiwan faced major vaccine shortages due to Covax production delays and the slow development of a homegrown alternative injection.

When Taiwan was hit by its worst Covid outbreak in a year in May 2021 after months without a single local case, vaccine donations poured in from the US, Japan, Lithuania, Slovakia and the Czech Republic. But figuring out how to distribute them efficiently was the next challenge.

Taiwan’s government initially followed a system of rationing vaccines based on age, occupation, and other health risks to ensure that as many people as possible received their first dose, before moving on to second and subsequent boosters.

Once again, g0v stayed involved, as members helped develop a centralized website for finding nearby immunization centers (although the immunization registry could also be found on individual hospital websites).

Cofacts, an existing g0v project to fact-check fake news, has also started publishing posts debunking a rise in misinformation about Covid-19 and various vaccines.

Despite this wave of misinformation, Taiwanese have been largely receptive to immunization. Vaccination rates are over 80% for the first dose, over 75% for the second dose, and now over 30% for a third booster shot, starting in mid-February.

Vaccinations are recorded in vaccination booklets, although simple QR-based digital certificates can also be printed or added to apps like Apple Wallet.

Taiwan’s success with Covid would not be possible without the ‘buy-in’ of a society that has continued to use QR-based tracking and carefully follows other government guidelines such as mask wearing and social distancing.

“Most people in the US don’t want to be tracked, but in Taiwan, if you say we’re tracking you for pandemic purposes, most people will accept it,” says Jason Wang, a professor of pediatrics and health policy. at Stanford University. , who has published academic papers on Taiwanese contact tracing and the response to Covid-19.

Wang says that a key factor driving willingness to cooperate is that many Taiwanese lived through severe acute respiratory syndrome (SARS) 20 years ago. So when Covid-19 emerged, both government and society were more prepared and willing to act than most places.

“People were scared by what happened during SARS, and there’s a sense of self-preservation and social solidarity from that. [experience],” she says.